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The following forms can be downloaded and printed. Please fill out the forms and bring in all required documents to the clinic to establish a new chart. If you have any questions, please call 505-908-2307.

 

Do Not Email forms back to clinic, they will not be accepted.

New Patient Forms
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CBNHC New Patient Registration Packet 2022

Click Here For Forms

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NoticePrivacyPracticePamphlet-2014

Click Here For Pamphlet

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Sports Physical Forms

Click Here For Forms

Sports Physical
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Parent - Legal Guardian Authorization Form

*Note: This form must be signed at the Clinic in front of Patient Registration staff. A valid State issued ID is required at the time of signature.

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Authorization to Appoint a Personal Representative Form

*Note: This form must be signed at the Clinic in front of Patient Registration staff. A valid State issued ID is required at the time of signature.

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